House investigators fault disability rulings as lax

Say many claims approved were initially rejected

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In 2007, Social Security commissioner Michael Astrue set productivity goals for judges.

By Stephen OhlemacherAssociated Press
June 25, 2013

WASHINGTON — The Social Security Administration is approving disability benefits at strikingly high rates for people whose claims were rejected by field offices or state agencies, according to House investigators.

Compounding the situation, the agency often fails to do required follow-up reviews months or years later to make sure people are still disabled.

Claims for benefits have increased by 25 percent since 2007, pushing the fund that supports the disability program to the brink of insolvency, which could mean reduced benefits. Social Security officials say the primary driver of the increase is demographic, mainly a surge in baby boomers who are more prone to disability as they age but are not quite old enough to qualify for retirement benefits.

The disability program has been swamped by benefit claims since the recession hit a few years ago. Last year, 3.2 million people applied for Social Security Disability or Supplemental Security Income.

In addition, however, management problems ‘‘lead to misspending’’ and add to the financial ills of the program, investigators from the House Oversight and Government Reform Committee say.

‘‘Federal disability claims are often paid to individuals who are not legally entitled to receive them,’’ three senior Republicans on the House committee declared in a March 11 letter to the agency. Among the signers was the committee’s chairman, Representative Darrell Issa of California.

Social Security acknowledges a backlog of 1.3 million overdue follow-up reviews to make sure people still qualify for benefits. But agency officials blame budget cuts for the backlog, saying Congress has denied the funds needed to clear it.

Increased workload

Social Security spokesman Mark Hinkle said the agency follows the strict legal definition of disability when awarding benefits. To qualify, people are supposed to have a disability that prevents them from working and is expected to last at least a year or result in death.

‘‘Even with this very strict standard, there has been growth in the disability program, and the primary reason for this growth is demographics,’’ Hinkle said.

The most common claimed disability was bone and muscle pain, including lower back pain, followed closely by mental disorders, according to the program’s latest annual report.

‘‘Pain cases and mental cases are extremely difficult because — and even more so with mental cases — there’s no objective medical evidence,’’ said Randall Frye, a Social Security administrative law judge in Charlotte, N.C. ‘‘It’s all subjective.’’

Nearly 11 million disabled workers, spouses, and children get Social Security disability benefits. That’s up from 7.6 million a decade ago. The average monthly benefit for a disabled worker is $1,130.

An additional 8.3 million people get Supplemental Security Income, a separately funded disability program for low-income people.

If Congress doesn’t act, the trust fund that supports Social Security disability will run out of money in 2016, according to projections by Social Security’s trustees. At that point, the system will collect only enough money in payroll taxes to pay 80 percent of benefits, triggering a 20 percent cut in benefits.

Congress could redirect money from Social Security’s much bigger retirement program to shore up the disability program, as it did in 1994. But that would worsen the finances of the retirement program, which is facing its own long-term financial problems.

The House oversight subcommittee on entitlements is scheduled to hold the first of several hearings on the disability program Thursday. Most Social Security disability claims are initially processed through a network of local Social Security Administration field offices and state agencies, usually Disability Determination Services, and most are rejected. If your claim is rejected, you can ask the field office or state agency to reconsider. If your claim is rejected again, you can appeal to an administrative law judge employed by Social Security.

The hearing process takes an average of a little more than a year, according to Social Security statistics. The agency estimates there are 816,000 hearings pending.

So far this budget year, the vast majority of judges have approved benefits in more than half the cases they’ve decided, even though they were reviewing applications that had typically been rejected twice by state agencies, according to Social Security data.

Of the 1,560 judges who have decided at least 50 cases since October, 195 judges approved benefits in at least 75 percent of their cases, according to the data, which were analyzed by investigators.

The agency denies there is a case quota for judges, saying the standard is a productivity goal. The agency has declined to comment on the lawsuit. Former Social Security commissioner Michael Astrue said he set the goal in 2007 to help reduce the hearings backlog.